Trimethylamine N-Oxide Levels Are Associated with Severe Aortic Stenosis and Predict Long-Term Adverse Outcome

Figures

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  Figure 1. Serum TMAO levels in patients with or without aortic stenosis. (A) Frequency distribution histogram of serum TMAO levels in AS population, n = 299. (B) Violin plot of TMAO levels in patients with AS (n = 299) or without AS (control group, n = 711) before and after propensity matching (n = 126 in both groups). (C) TMAO achieved a receiver operating characteristic curve area under the curve of 0.69 with a best cut-off value of 2.81μmol/L. (D) Violin plot showing no significant difference of TMAO levels in different grades of aortic valve calcification (one-way ANOVA p = 0.201). Data are presented as violin plots with median (solid line) and quartiles (dotted line) in (B,D). (E) Correlation between TMAO and aortic valve area (AVA) in AS after common logarithm transformation. TMAO = Trimethylamine N-oxide; AS = aortic stenosis; cTn = cardiac troponin; proBNP = N-terminal prohormone of brain natriuretic peptide; AVA = aortic valve area.

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  Figure 2. Late cumulative and 2-year event rate of mortality according to elevated TMAO. Kaplan–Meier analysis of late cumulative all-cause mortality (A), cardiac mortality (B), and non-cardiac mortality (C) stratified by TMAO levels in AS patient after TAVR. TAVR = transcatheter aortic valve replacement. TMAO = Trimethylamine N-oxide.

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  Figure 3. Late cumulative all-cause mortality according to combinations of TMAO and STS or proBNP. Kaplan–Meier survival analysis for late cumulative all-cause mortality stratified by (A) combinations of TMAO and STS score and (B) combinations of TMAO and proBNP, reporting none, one, or both elevated. TMAO above 6.91 μmol/L (Q4), proBNP above 2871 pg/mL (median), STS score above 8 (high risk), respectively. TMAO = Trimethylamine N-oxide; STS = Society of Thoracic Surgeons; proBNP = N-terminal prohormone of brain natriuretic peptide.